RIGA conference – April 2004

Prevention is a much abused word; I would hope you would all agree with one of my most respected mentors, Bill Lofquist , who said:

“We need to get beyond the notion that prevention is merely stopping something happening, to a more positive approach which creates conditions which promote the well-being of people”.

Culture is another word that can be interpreted in many ways.. But the definition of culture which we are ordinarily engaged with is

“The Attitudes and Behaviour of Particular Social Groups”.

3. HOW DOES CULTURE INFLUENCE BEHAVIOUR?

With acknowledgements to American prevention expert Bill Oliver, here’s a model … the Tree of Behaviour. And here are the stages of its growth. (powerpoint slides shown here)

The Tree of Behaviour doesn’t grow out of nowhere – it isn’t spontaneously created; it is the outcome of a process that is largely invisible. Invisible because it is below ground; it has roots. Within each of us – As external impulses reach our centre of consciousness, our intellect, will and emotion respond to the impulses, and the outcome is that we develop a thought. We review that thought – ‘yes/no/maybe’ – and in the process we develop an attitude towards it. Our attitude towards any action we are contemplating is probably the first visible sign which others can see – like the first green shoots of a tree coming up through the ground. This is why, as parents, we need to be vigilant about the attitudes our children display.

What I want you to concentrate on, though, is that internal, ‘underground’ phase – before the attitude develops. In this seminal stage, a great many influences apply. Memories – good and bad. Using those memory banks to project images of what might happen if this behaviour is followed. Values and boundaries for the individual. Weighing advantages and disadvantages to oneself and to others. Applying learning received so far. Peer pressure and role models. The drive for personal pleasure. Curiosity and risk taking. Pain and how to avoid it. Feelings of spirituality and faith – or the lack of them. All these and more will influence the nurturing of that first thought, and will decide whether we reject it – or decide to act on it. This is ‘the culture in which decisions are made’.

If someone alters the culture within which decisions are made, it is virtually certain that there will be different outcomes. The Values Clarification philosophy founded by Carl Rogers and Professor Sidney Simon (and which also drew in part on the thinking of their contemporary, Abraham Maslow) when combined with other liberally-inclined arguments produced a juggernaut that crushed large sections of the morally-based opposition. Not including us!

4. NESTS OF CULTURE

Consider first this simplified hierarchy – or ‘nest’ of cultures:

Societal factors overlay and add to the culture. There is no shortage of societal factors which tend to encourage drug abuse. Here are some examples:

Conspicuous consumptionSearch for Rapid gratification Rights but no responsibilities The ‘Right to be Happy’Self before society Youth are the Supreme BeingsPolitical Correctness

Politics is a culture all of its own, operating in its own idiosyncratic way. History shows the emergence of ‘intellectuals’ giving succour to drug abuse – rationalising it as a ‘legitimate’ expression of disaffection for conservative/’right wing’ ideology and authority. Liberalism was born out of reaction to the tyranny of monarchies and other hard-line authorities, but when democracy replaced these despots, liberalism – instead of stepping back – went on a quest for justification of its continued existence, and in the process became a perversion of its earlier noble purpose – and a tyrant as ruthless as any it once fought to depose. Liberal forces tend to have lots of money and resources; there is therefore the very real risk that the European Parliament will recycle the pro-drug culture’s statements, presenting them to the unwary – especially in the new Enlargement Nations – as ‘wisdom from the centre’

And of course one massive player in the culture game is The MEDIA. The ‘messengers’. The rulers of the magnificent city which is Rome used to have a tradition of killing any messenger who brought bad news – if we continued this practice these days we wouldn’t have any journalists left! But instead we seem to expect bad news – and disbelieve anything good we hear. Meanwhile the messengers have transformed themselves from reporters of the news into makers of the news – filtering everything through their own belief system.

The newspapers’ colleagues in print, the magazines, are amongst the strongest promoters of hedonism. ‘Style’ magazines like Face, FHM, ID, Ministry, have long pursued a love affair with ‘lad/ladette’ behaviour – heavy drinking, ‘caning’ (drugs), promiscuity are all seen as milestones which all must pass to gain entry to the World of Cool. Even the youth magazines – like Bella, 19, and Just 17 – all of which are regularly read by those much younger than their ostensible readership age – have an unhealthy pre-occupation with sex. In addition to these ‘generic’ magazines, there are of course the ‘specialist’ magazines like ‘High Times’, ‘Cannabis Culture’ ‘Heads’ to cater for the dedicated doper – and to intrigue the casual reader.

Films rely on something called ‘Product Placement’ to boost their revenue – this is the inclusion of commodities on the screen to make people want to buy them. It works for commercial products – but it also works for things like drugs, which are many times included in the action with no justification in the storyline, and with inappropriate audience ages … ET and Crocodile Dundee are just two examples of this malpractice. Posters. Tee shirts. The fashion industry with its exploitation of ‘heroin chic’.

5. PREVENTION AND ITS ENGAGEMENT WITH CULTURE

‘Anomie’ (anything goes) to ‘Authoritarianism’. Advocates of drug legalisation have attempted to tendentiously pigeonhole John Stuart Mill in the ‘self-interested’ culture, quoting his statement that

“Over himself, and over his own mind and body, the individual is sovereign”.

but they ignore his saying that

“Whenever, there is definite damage, or risk of damage, to an individual or the public, Liberty (must give way to) Morality or Law”.

You might say this means that conscience erects a ‘Stop’ sign when one’s ‘self-will’ is speeding. Without this control system, self-will proceeds onto the assumption that one has a ‘personal right’ to this behaviour, thence to the notion that there is a ‘constitutional right’ to the behaviour, and thus to a pressure to legalise it. If we do not want to be ruled by tyrants in future, it is in all our interests to promote conscience now. According to Coulson, this means going back to what he sees as the three core institutions – family, church and university, and instilling a health-promoting model in all of them.

8. HOW CAN WE STRENGTHEN PREVENTION CULTURE?

Generic activities:

• Understand and work to the model of ‘Total Health’

• Advance the concept of ‘Everyone, not just Number One’

• Expose and dispose of ‘Values Clarification’

• ‘Cultivate the Conscience’

Improve Reality:

• Establish primary prevention as main criterion in drug education All education should have prevention in mind

• Put harm Reduction where it belongs Part of treatment, not a policy in itself

• Police get a ‘Pizza the Action’ Prevention by police/community initiatives.

• ‘Cool to be clean’ tee shirts, and similar promotions Give your creative people a chance to shine!

• Music Art and Drama re-energised with prevention in mind

• Support the ‘Prevention Institute’ Seek out the worldwide family of relevant Institutions

But at the very least we can be sure that our efforts in prevention have a high purpose, are altruistic, and tend to enhance the quality of life in a way that is sorely needed in the social and spiritual desolation which typifies too much of society today.

What are the indications for Latvia?

As an advocate of prevention you would expect me , I’m sure, to advocate that Latvia commits to prevention. But I hope I can give you put a little more balance than that. You should know that in the first half of my 20 years in this field, I worked in treatment, as a counsellor for people with a problem, as an advocate in the justice and police system and has a specialist adviser in schools. so in these suggestions I’ll try to reflect that width of vision.

This would be a fortunate country indeed if every drugs service that was needed were to be in place – and to be present in sufficient quantity and of adequate quality. In reality, I know of nowhere where these Utopian conditions have been achieved. The best we can do is to optimise placement of resources, and to keep them under continuous observation, so that as conditions change, the services change.

(At this point a power point presentation was made – including describing in detail the Jellinek curve. the argument for much stronger universal prevention. Explanations of indicated and selective prevention. true and so-called ‘Harm Reduction’. )

The Rome conference was commendable in looking as widely as possible at the many factors influencing human behaviour. In today’s brief conference I would recommend you to keep this principle in mind. Don’t imagine that if you apply a push to one point that you will move the whole structure – as a former civil engineer, I can assure you that is very unlikely to happen, and what you’re more likely to do is to over stress that part of the structure you’re pushing and cause the whole thing to fall down on top of you. The lesson of this is that you need to have a good appreciation of the whole picture of each section interacting with another. Another analogy would be to call this whole environment around drug use a social ecology – I would hope we have learnt enough about ecology to understand the risks of tampering with just one part of whilst ignoring the rest. The best advice is – move slowly, move cautiously.

If I had to sum up where most of the conflict arises in drugs services, apart from haggling about which service gets how much money, I would say that it comes from the struggle between the rights of the individual and the rights of society. (John Stuart Mill) This always has been, and probably always will be, a never ending tug of war. the best we can do is to recognise that the individual and society both have rights and it is the duty of government to act as the referee – even if all the players and the onlookers shout for your death! In that thankless task I wish you best of luck.

Thank you.

SECOND PAPER – CANNABIS AND SYNTHETICS – SCHOOL SYSTEMS.

Antonio Maria Costa, the Head of INCB, gave a worrying warning to us all last when he said that synthetics will be the major drug problem in future. Why might this be? And how far away is this future? Should we drop everything we are doing now and concentrate only on synthetics? And what are synthetics anyway? We can’t even agree on the definition of a ‘drug’ – let alone what a synthetic one is.

And what’s really happening in schools. When we say we want schools to prevent use, what are we also saying? That the rest of us can switch off? I don’t think so! And when we issue statements as to what teachers must do, how much do we measure the possibility of them doing this within their present workload? What about their own attitude and learning about drugs? And how many of them are drug users? How many have swallowed the gospel according to Saint Maslow? And to what extent is any kind of ‘freedom’ almost welcomed in this post-Soviet era – and because of this, is any attempt at prevention automatically decried as repression/repressive? This is where culture comes in – and I tried to open that subject for you this morning.

So what we are facing here is an enormous journey – a journey of learning as well as teaching. But the Buddhists will tell you that the longest journey begins with a single step, therefore let us see if we can take that first step today.

The first thing is to define what are we trying to achieve. If you are just trying to achieve a peaceful life in your school, you can expel any one you suspect of drug use so that they have to go to somebody else’s school. Of course there is the risk and you will have to take people who are expelled from another school, and so the merry-go-round continues. But I suggest to you that you are trying to achieve more than this. Firstly you are trying to achieve healthy young people in a Healthy school which is part of a healthy society. Secondly, you are trying to achieve succes here, and people in a successful school which contributes to a successful society.

Now I need to define what health means. Why? Because in a society which is heavily influenced by medicine, we tend to think of ‘health’ as just the absence of sickness. and when somebody is defined as ‘well’ , we define this in terms of how fast they can run 100 metres. Say someone has just stolen your wallet with all your money and then runs away – covering 100 metres in 10 seconds, would you look at them and say they are truly healthy? I don’t think these will be the words on your lips.

Health is a great deal more than the absence of sickness, and you can find much more complete definitions of it even in ancient writings. more recently there are definitions which match these earlier ones, such as that by the World Health Organisation, which match these earlier ones. The definitions generally agree that health is a combination of physical, mental, intellectual, social, emotional, spiritual and environmental aspects. In order to be fully healthy, one has to be scoring well on all these aspects and this is why the school curriculum needs to address the whole person, not just the academic person – but it needs to do so within a clearly defined and accepted moral framework, which balances individual liberty against responsibility to others – a theme I touched on in my previous paper.

How can you achieve this full health? I suggest that you need to involve and gain commitment from everybody in the school, and I mean everybody – from the Head and the teachers, to the caterers and the janitor – not just the pupils. The starting point for this is a school drug policy which promotes health – not just imposes discipline. I can tell you that in my own country a great many of these policies developed by schools start with what I would call Chapter Three of the complete book. Chapter Three says what we will do with a pupil when we discover them using drugs. But the policy is silent on Chapters 1 and 2; Chapter 1 says ‘what are the goals of this school’ and Chapter Two says ‘how are we going to achieve those goals’. These are the chapters in which you set out your PREVENTION plan – if you only start at Chapter Three then I’m sorry to tell you that you have a sick policy, not a healthy one.

I can tell you much more about what ought to go into a school policy, but I cannot cover it fully in the time I have today. So let me give you some examples of what you could do

Draft a policy for your school along the lines I have suggested above. Then discuss it with your school’s teachers, with your school’s governing body or committee, with the parents of your pupils and with the pupils themselves. You can do this even in primary-schools, although it will be at a lower level. You could interact with parents by a combination of survey forms and focus groups. You need to involve all of these because you want them all to ‘take ownership’ of the policy – and in doing this they will be more likely to adhere to it.

Structure your curriculum with the goal of a health-promoting school, and then Staff it with that in mind. I have seen a number of schools where a particular teacher is nominated as ‘the drug teacher’ – not because they are perfect for the job, but because nobody else wants it. You might as well hand out drugs at the school entrance if you’re not going to be serious about this subject. Bear in mind that school teachers may be required to share any information pupils give them, share it with the head teacher, or parents, or even the police. If you have discovered a pupil who is dealing drugs to others then it is right that you should tell all these other people, but if what faces you is a pupil who has just started using drugs in response to some form of emotional distress or disturbance, then you need a different response, one that probably involves individual, confidential counselling. If your school does not have pastoral counsellors who have the power to keep information confidential, then you may have to make an arrangement with an external counselling agency where pupils can be referred to cover this need.

What about the actual process of ‘educating for prevention’ – can you educate to prevent? I would say “only sometimes”. Consensus of research into behaviour is that if you wish to modify it you must address three subjects – known simply as KAB. Knowledge, attitudes and behaviour.

Knowledge is what you can deliver in the classroom, but just transmitting knowledge does not necessarily change behaviour – only sometimes, as I have said. Attitude can also be addressed in the classroom but needs to be addressed more widely throughout the school; you can challenge and mould attitude during class lessons, in debates, through the school newspaper, by the informing and sustaining of discipline, and by good examples. What the research also shows is that even though you may change attitudes this does not automatically change behaviour. You need to specifically address behaviour to a improve your chances of achieving a health promoting school.

Behaviour is the toughest one to tackle, because it is the most volatile. It is a combination of encouragement and discouragement, of positive reinforcement for behaviour which you welcome – not just a process of punishment for behaviour of which you disapprove. When it comes to disciplinary responses, these need to be in accordance with the consequences which everybody has been told about and acknowledged when they first join your school. They need to be consistently applied but this need not mean rigidly applied – the way you have written your drug policy should give you scope for sensible and sensitive discretion on how you deal with each person.

The shortage of time precludes me from going into more detail about random student drug testing, restorative justice schemes and the use of Peer Education projects for prevention. Please feel free to contact me at the National Drug Prevention Alliance if you wish to further this discussion. I thank you for the invitation to share our views on Drug Prevention in the schools setting. My colleague (and wife) Ann will now give you a presentation about a successful drug prevention programme called Teenex which was written in 1988.

I have been asked by Sandra Rubene to give you a re run of the paper which I presented at Rome – and to give you best value in the time we have, what I propose to do is not only that, but also to give you a quick overview of the rest of the happenings in the Rome conference; what the conclusions were, and then to wrap up this first session by suggesting how you might take this information – and apply it in Latvia.

In September 2003 for Fifth Global Conference on Drug Prevention was held in Rome. 500 delegate 8th from 84 nations attended – including your own Aelita Vagale .

The atmosphere of this conference was something special. There was not just the usual concentration on the pharmacology of drugs, their physiological effects and how to educate against the use, valuable though that is. All of those subjects were covered, but in addition there was a vigorous examination off for the effects of culture on drug use, the value of religion in countering drug use, and an old subject under a new title – bio-ethics, meaning the interaction of ethics and human nature. It was this a holistic approach that made this conference so exciting and so memorable.

Another memorable aspect was the enormous commitment shown by the Italian government; no less than 11 senior figures from the government of Italy attended. This included the Vice Prime Minister, Gianfranco Fini, the Co-ordinator of National Anti-drug Policies Pietro Soggiu, and ministers within departments as Health, Social Affairs, Regional Affairs, Prisons, and the Interior. The unified message coming from this extraordinary assembly of officials is one that I would commend to Latvia. I will come back to this in more detail at the end of this paper, but for now, will tell you that their conclusion was that they had tried for long enough to make peace with the drug culture; they had now decided that this had only made things worse, not better, and a new direction was essential.

Of the other delegates at the conference the there were many who were notable. The first Lady of Bolivia spoke on the first day. She was joined by US Congressman Mark Souder. The Swedish Minister for Public Health and Social Services was there, as were an impressive array of academics from many countries. This was Rome, so we were fortunate in hearing from the Papal Nuncio and several of his senior colleagues from the Vatican. But we also had representatives of Islam, Hinduism, Judaism and Buddhism, who all gave papers – and all these faiths showed a remarkable degree of unity in their definitions of what constituted Responsible Behaviour in their communities.

So let’s move now to my paper. I’m going to give you a shortened version of it here, but the full version has been given to Sandra. It was entitled ‘Prevention strategies and the Cultivators of Culture’.